Zika virus prevention

Pregnant Woman Spraying Mosquito Repellant To Protect Against Zika Virus
Pregnant Woman Spraying Mosquito Repellant To Protect Against Zika Virus

Funding for Zika Virus is making slow progress in Congress, which is affected by politics.  Our scientific community needs encourage our politicians to take action without partisan politics. Many other countries are taking measures to reduce the spread of Zika virus, while we are debating over funds for such an important cause. With recent floods in many states, the environment is ripe for the spread of the virus unless the government takes urgent measures for control mosquitos.

Many countries have intensified vector control operations to control the Aedes mosquito population. Vector control measures include:

  • Inspecting all premises, ground and congregation areas
  • Conducting mandatory treatment such as ultra-low volume misting of premises and thermal fogging of outdoor areas to kill adult mosquitoes
  • Increasing frequency of drain flushing and oiling to prevent breeding
  • Public education outreach and distribution of insect repellents.”
    According to CDC, also, to bite by an infected Aedes species mosquito, Zika virus can spread from:
  • Sex with a person who is infected by Zika virus.
    The sexual transmission can take place during oral, vaginal, anal sex as well as the sharing of sex toys.
  • From an infected pregnant woman to her fetus.
  • Through blood transfusion.
    According to CDC the most common symptoms are:
  • Fever
  • rash
  • joint pains
  • red eyes
  • muscle pain
  • headache

For more information on personal protection go to http://allergistlafayette.com/site/blog/zika-virus.html

All physicians and anyone involved in taking care of patients need to participate in public awareness. Zika virus infection has been a topic of discussion in many international airports to increase public awareness and educate travelers of the risk of Zika virus exposure when they travel to a foreign country.



Zika Virus

mosquito bug isolated on white
mosquitoes and Zika Virus

Beyond Allergy – Zika Virus – a prevailing threat

Powlin Manuel MD, MBA, MS.
Zika virus threat seems to be closer to home than we anticipated with new cases being reported in Florida. Threat of difficulty to control mosquitoes that carry the virus is even more with the enormous flooding in recent days in Louisiana. All physicians need to participate in spreading the information provided by CDC to their patients so that everyone can implement “baby steps” to protect from the infection as well as the spread of the virus.

Zika virus is spread by a type of mosquito called Aedes aegypti. Center for Disease Control(CDC) informs that “different mosquitoes spread different viruses and bite at different times of the day”.
CDC informs us that these mosquitoes spreading Zika virus bite primarily during the daytime, but can also bite at night.

CDC recommends using insect repellents to reduce the chance of getting bitten, in addition to use of protective clothing.
The following brand names are published by CDC for information of our patients. These include: Off, Cutter, Sawyer, Ultrathon, Cutter Advanced, Skin So Soft Bug, Guard Plus, Repel, and SkinSmart.

Authorities in USA use aerial spratying regularly to control mosquitoes. However, it is not easy to control these moqquitoes as
“aegypti eggs are capable of surviving adverse conditions, such as dry or cold weather, as well as vector elimination efforts, including insecticide spraying .. efforts to eliminate Zika virus in a region will be more difficult than removing the adult vectors” (researcher Dave Muoio). “Spraying affects adults, but it does not usually kill the immature forms — the eggs and larvae. Spraying will reduce transmission, but it may not eliminate the virus.” the research reports states.
All of us need to be informed, vigilant, and takes measures to protect our families!

More on mosquito-repellents

Beyond Allergy – Insect Repellents and Protection against Zika Virus

Powlin Manuel MD, MBA, MS

To protect against mosquito bites is the most important step in preventing Zika Virus infection and consequent medical conditions. Zika virus is spread by a type of mosquito called Aedes aegypti. Center for Disease Control (CDC) informs that “different mosquitoes spread different viruses and bite at different times of the day”.

Aedes aegypti bite primarily during the daytime, but can also bite at night.

Insect repellents are the best source of protection to reduce the chance of getting bitten, in addition to use of protective clothing.

The following brand names are published by CDC:

  • Off
  • Cutter
  • Sawyer
  • Ultrathon
  • Cutter Advanced
  • Skin So Soft Bug
  • Guard Plus
  • Repel

Authorities in USA use aerial spraying regularly to control mosquitoes. However, it is not easy to control these mosquitoes.

CDC cautions that the effectiveness of natural insect repellents not registered with EPA are is not established. CDC suggest the following as the best practices

  • Always follow the product label instructions
  • Reapply insect repellents every few hours, depending on which product or strength you choose.
  • Do not spray repellents on the skin under clothing
  • If you are using sunscreen, apply sunscreen first and insect repellents second.
  • Use EPA registered insect repellent.

Takes measures to protect our families from Zika Virus


HPV Vaccine and Cancer Prevention

Prevent cancer with HPV Vaccine
Prevent cancer with HPV Vaccine

Protecting our kids from preventable cancers

As a pediatrician and immunologist, it is frustrating to watch parents deny the teenagers the chance to be protected from HPV-related cancers. HPV-related cancers include cervical cancer, vulvar cancer, oropharyngeal cancer, cancer of penis, anus and rectum. HPV-related cancers are the only malignancies which can be prevented by vaccination. Despite the availability of a very effective vaccine, Center for Disease Control (CDC) reports that the number of these preventable cancers is increasing. Let us do something about it. All of us need to get involved in educating the public to give their kids the very essential HPV vaccine.

Pain and Narcotic Medications

Woman in pain from back injury wearing an orthopedic body brace corset, isolated.

Pain and narcotics have been a topic of serious discussion nationally in recent years. There are many chronic pain conditions such as low back pain for which patients seek medications. It is often very difficult to convince patients suffering from chronic or recurrent pain to stay away from narcotics. There is clear evidence that narcotic pain medications do more harm than good in any chronic pain.

A recent report in Journal of American Medical Association it was reported that there is no significant improvement in pain scores, and no substantial improvement in function or disability by use of narcotic pain medication in chronic back pain. On the contrary, the research shows higher risk for death from unintentional overdose and higher risk for heart disease-related deaths in patients taking narcotic pain medications.

Cosmetics Allergy

Aftershave lotion allergy
Aftershave lotion allergy

Cosmetics Allergy

Allergy to cosmetics is a common problem in women, while it rare in men. Cosmetic allergy usually result in reactions appearing 48 to 72 hours after contact with cosmetics. In some cases an  immediate allergic reaction can occur. However, allergic reaction resulting in rashes on face result from delayed reaction to chemical products used in the cosmetic.  These are called delayed reactions because they are conducted by immune cells which result in allergic reaction after 2 to three days of contact.

Irritant dermatitis is another form of skin reaction that occur is some cases. It is called irritant dermatitis because the tests will not show any evidence of allergy and the reactions which may look similar to allergic reaction. Redness, flat type of rashes, and even some lesions with blisters can result from irritant dermatitis.

Some shaving cosmetics can also induce dermatitis after exposure to sun light also. These are called photo-dermatitis since it happens only if the area is exposed to sun light following the application of the cosmetic. Musk ambrette is one such photo-allergens causing skin rashes on face. In these cases you may tolerate a cosmetic if you do not get exposed to sunlight, but causes skin rashes on exposure to sunlight. The effect of ultraviolet rays on the chemicals which do not cause a reaction until sun light changes the chemical nature into a allergen.

Tests for delayed reactions are done using fragrance ingredients in a patch test. It Patch tests are not widely available, and are usually done by dermatologists. Some allergy including Manuel Allergy Center can do these tests using a panel of allergens. This panel may not contain all the possible contact allergens. In some cases the actual cosmetic that needs to be tested can be brought to the office and test applied with your cosmetics. However, it is often difficult to decide the concentration which induces a reaction and it is considered a “crude” test as standards have not been established.

Watch the video on contact dermatitis due cosmetics.

Latex Allergy

Latex allergy
Latex allergy

Allergy to latex gloves

Latex allergy: 
Latex allergy can be a bothersome problem causing dermatitis on contact.  These can present as rashes on hand and foot and other parts of body based on the area of contact. Latex allergy often related to occupation which present a significant problem for daily living.
Rubber gloves, brassieres, shoes, girdles, contraceptives are the usual sources. Many components of gloves and shoes reactions are really bothersome for those who cannot avoid  exposure at work. Rubber sensitivity can be a direct cause of persistent dermatitis. If you already suffer form eczema latex can cause a flare up.
Diagnosis latex allergy
Allergy tests are available to make a diagnosis of latex allergy if needed. Very often the diagnosis is from clinical history of exposure and the pattern of rash it produces. If it is related to exposure to gloves as in the cases of medical professionals and workers wearing glove it becomes self evident without going through andy tess
Patch testing for to diagnose allergy to rubber-related products causing dermatitis.
Visit us at www.Facebook.com/pediatricallergist for information on allergies.

Selective Mutism, a communication disorder

Eight years old
Selective mutism

Selective Mutism – A Communication Disorder: Powlin Manuel MD, MBA, MS (PSYD).
With increased awareness of autism in recent decades, many of us get concerned when a child does not communicate with other children and teachers at school. Inability to speak outside the home, especially in school while they communicate perfectly at home is a problem faced by some children. Children with this disorder, who apparently are considered normal by parents, shut off completely in their communication with other children and teachers at school. This disorder is causing anxiety for parents as well as concerned teachers who may be worried that the child may be suffering from autism or other communication disorders.

Selective mutism results from an underlying anxiety disorder, especially social anxiety. These children are usually shy in the public even though they speak well at home, and maintain a normal communication with parents as well as siblings. Because of lack of knowledge on selective mutism, well-meaning teachers and parents implement measures such as forcing the child to speak. This will result in worsening of the situation. This will increase the underlying anxiety and will force to the child to be even shier.

How can we help children with selective mutism?
The way to deal with selective mutism is by taking measures to address anxiety and improve self-esteem. Many of these children suffer from poor self-esteem and anxiety due to fear of failure. The act of forcing the children to speak up will result in more anxiety, hence prolongation of selective mutism. On the contrary, any attempt by a child to express words should be encouraged by praising the child and facilitating even communication by non-verbal means such as whispering to teacher’s ears as the initial step toward gaining confidence in communication. Speech therapy and behavior therapy have been found to be useful. In cases where these measures fail, treatment with medication may be considered by the child’s physician. The following video sheds more light:

Selective Mutism

Selective Mutism
Communication disorder, selective mutism


Selective Mutism – A Communication Disorder: Powlin Manuel MD, MBA, MS (PSYD).

Inability to speak outside the home, especially in school while they communicate perfectly at home is a problem faced by some children. Children with this disorder, who apparently are considered normal by parents, shut off completely in their communication with other children and teachers at school. I am familiar with many children in this situation, the disorder causing anxiety for parents as well as concerned teachers who may be worried that the child may be suffering from autism or other communication disorders.


Selective mutism results from an underlying anxiety disorder, especially social anxiety. These children are usually shy in the public even though they speak well at home, and maintain a normal communication with parents as well as siblings. Because of lack of knowledge on selective mutism, well-meaning teachers and parents implement measures such as forcing the child to speak. This will result in worsening of the situation. This will increase the underlying anxiety and will force to the child to be even shier.


The way to deal with selective mutism is by taking measures to address anxiety and improve self-esteem. Many of these children suffer from poor self-esteem and anxiety due to fear of failure. The act of forcing the children to speak up will result in more anxiety, hence prolongation of selective mutism. On the contrary, any attempt by a child to express words should be encouraged by praising the child and facilitating even communication by non-verbal means such as whispering to teacher’s ears as the initial step toward gaining confidence in communication. Speech therapy and behavior therapy have been found to be useful. In cases where these measures fail, treatment with medication may be considered by the child’s physician.








Peak Flow Meter: a very useful tool for Asthma management

Peak flow meter
For asthma treatment

Peak Flow Meter is an old tool very useful for optimal management of Asthma. Still it not utilized as much as it should be.

Peak Flow Meter is one of the tools used for evaluation of the state of airway function. Peak flow meter gives a quick reading of the airflow and hence airway functions.

At Manuel Allergy Center, patients are given training on the use of Peak Flow Meter and are provided with a chart to record the results regularly when the patients are symptom-free. Peak Flow recordings are also made when there as symptoms of cough or chest tightness. This gives the patients an opportunity to compare the numbers during the symptom-free states and its deviation on exposure to triggering factors such as exercise, tobacco smoke, exposure to work-place irritants, etc.

Usefulness in treatment of asthma

The numbers shown by measuring peak flow help the patients decide the next course of action to get relief of asthma symptoms as well as to prevent an attack of asthma by proactively using relief medications such as Ventolin or Proventil. A drop in Peak Flow measurements of more than 20% will require the use of inhalants, and a reduction of 50% may require a visit to emergency room or urgent care centers for immediate treatment.  The readings also give us information on the risk factors for induction of an asthma attack.

Visit here for instructions

Breast feeding instructions – updated information

Breast Feeding

Updated information on breast feeding.
Updated information on breast feeding.


Breast-feeding is the most ideal feeding for your baby; it is natural; it is healthy. Breast-feeding is a normal process in our life, come naturally as an instinct. It is amazing how the process works! Hormones released from the brain of the mother changes to facilitate the instinct to feed the baby. There should be no doubt that breast feeding will occur normally and naturally. The problem is too much information. Mothers read too much; getting so many conflicting pieces of information. Too many conflicting views often lead to maternal anxiety. Even the instruction pamphlets provided at the hospital make it sound like it is an impossible task. Many of these instructions are written by “experts’ with an agenda for exclusive breast with so many strict instructions which make the new mothers feel insecure, inducing a fear of failure. Breast feeding should be conducted in such a way that it does not affect your reasonable lifestyle. The fear of having to follow strict practices, I find is the reason for discontinuation of breast feeding too early even by well-meaning mothers.

Good Practices for Breast Feeding

The following is considered some good practices to follow; but not the only ones, there are many approaches.

  • Find a comfortable place; be relaxed.
  • Wipe the breasts with warm water before feeding.
  • Do not feed more than 15 minutes from each breast; always alternate and feed from both breasts.
  • Do not let the breast become swollen and painful because of the retention of excess milk will cause pain.  Expressed milk using breast pump or done manually, could be saved for feeding your baby later.
  • Be flexible; there are different ways to achieve the same goal; not being flexible and strictly adhering to a ritual in pumping breast induces anxiety in many mothers. There are many ways to things, including breast feeding; they all produce the same good result.
  • It is OK to add supplemental formula if you feel that you are not producing sufficient volume of milk. There is not scientific evidence to state that supplemental feeding is inferior to exclusive breast feeding. It is very common not to have enough volume of milk for many days after delivery as there may be a delay in the production of a releasing hormone from the brain for various reasons. If the baby does not receive enough quantity of breast milk after sucking 15 minutes from each breast, is is OK to add a formula.

Your diet during the period of breast feeding:

You could continue with your regular diet.  However, if any item of your food items is associated with excessive crying, you may avoid them. Recently there has been some concern raised about eating fish during pregnancy and lactation because of concern of high mercury level in fish. The Environmental Protection Agency has suggested that the breast feeding mothers avoid eating

  • shark,
  • sword fish,
  • golden bass,
  • king mackerel and
  • albacore tuna.  The net effect of eating fish is beneficial. Some studies have suggested favorable effects of maternal fish consumption on infant’s behavior attention scores, visual recognition memory, and language comprehension.

Is your baby getting enough milk?
This is a question many parents ask. It is difficult to decide if the baby is receiving enough fluids in the first 10 days after birth. If the fluid intake is less than sufficient, there is a higher chance of developing jaundice. The incidence of jaundice is higher in breast-fed babies, one the reason being not enough intakes of fluids. Breast milk flow in the first week may not be sufficient. It takes a few days for the milk to flow sufficiently. Usually it is not a problem. I advise giving some distilled water after feeding 15 minutes from each breast. If the baby still continues to drink, the baby probably did not have enough milk.
There is no harm to supplement with additional formula feeding along with breast feeding especially during the first ten days after delivery. There is a big debate over this issue as some mothers read about the importance of exclusive breast feeding. There is no research evidence to support this view.
In case you have not started the let down of milk yet, additional formula feeding will help. Working mothers can feed before going to work, give  formula during working hours, and feed from breast after returning from work. Some institutions accommodate the use of a breast pump during the working hours. Recent changes in work place rules encourage management to provide a special area for breast feeding by the employees.